Canadian Co-operative Investment Fund...c4PJ!3+/./A!.!A;+/3.,R! J5??4+./A!4+!

#90-425 Carrall Street, Vancouver, BC V6B 6E3 [email protected] #400-119 Spadina Avenue, Toronto, ON M5V 2L1 ccif-fcic.coop 1

Loan Application – Part 2

You are requested to complete Part 2 of the CCIF Application as described below in order for CCIF to pursue the review of your request for a loan or investment for your co-operative. This is not a letter of intent or a letter of commitment and does not commit or obligate CCIF in any way to provide a loan or investment. The checklists below are provided as a tool to assist you in collecting information for Part 2 of your CCIF loan application. Where information requested is not available or not relevant please indicate this. A section of Part 2 of your CCIF loan application requests information about the impact that your project will have on the community and how you plan to monitor that impact. Please see Appendix II for more information on CCIF’s impact measurement and management framework. Once we receive all of the above requested and applicable items, together with the payment of the $750 application fee, we can complete our analysis of your co-operative’s request to CCIF, further assess your eligibility and provide a term sheet. Please contact us you have any questions or require assistance in completing the application. We look forward to working with you. Contact: Christina Baker Email Address: [email protected] You may also reach us by telephone at 613-366-1169 or e-mail [email protected]. Mailing Address: Canadian Co-operative Investment Fund #90-425 Carrall Street Vancouver, BC V6B 6E3



Loan Application – Part 2 – Required Documents Checklist Please provide all of the below documents below together with your application.

Completed Loan Application – Part 2. Business Licence (where applicable). Please provide a copy of your co-operative’s

business licence. Bylaws. Please provide a copy of your co-operative’s bylaws. Copy of Business and Liability Insurance. Bank and Funder References. Please provide names and contact information for credit

unions, banks, funders and/or other sponsors whom CCIF may contact for references. Copy of Government-issued Photo ID. Please provide a copy of government-issued

photo ID for the person(s) who has signing authority at your co-operative. $750 Part 2 Application Fee. Please mail a cheque payable to Canadian Co-operative

Investment Fund LP to #90-425 Carrall Street, Vancouver, BC V6B 6E3.

Loan Application – Part 2 – Additional Checklist for Facility Project

Please provide any applicable documents listed below together with your application.

Project Scope of Work. Please include a complete scope of work for the project, including a description of the facility: (a) square footage; (b) year facility was constructed; (c) planned uses and, if applicable (d) landmark or historic district designation.

Itemization of Machinery and Equipment (where applicable). Please list the names, model numbers and estimated costs of equipment you plan to purchase with loan proceeds.

List of Current Facilities. Please list all facilities currently owned or leased and include the address, use of the facility, total square footage, name of the lender (if owned), annual rent (if leased) and any securities held.

Project Budget and Projections. Please include a complete list of sources and uses of funding for the facility project as well as a complete budget and projections showing capital project expenditures and funding by month.

Project Schedule. Please attach a narrative and/or spreadsheet describing the timeline of your project and complete construction schedule.

Purchase and Sale Agreement (where applicable). Please attach a signed copy of the negotiated purchase agreement or letter of intent and all available exhibits.



Real Property Collateral Information and Appraisal. For the real estate to be provided as collateral in the transaction, please provide the Tax Assessment ID number, legal description and most recent appraisal of the property. If an appraisal is not available or property value has changed since the last appraisal has occurred, a new one may be required. If real property taken as collateral is in a flood plain, proof of flood insurance will be required.

Construction Contracts. Please provide a signed copy of any contracts with architects, engineers, project manager, general contractors or any other involved party.

Plans and Specifications. Please provide a copy of any architectural drawings. Completed Environmental Questionnaire. Please see Appendix I for the questionnaire

template.



IMPACT MEASUREMENT

PROJECT and/or CO-OP - SPECIFIC IMPACT METRICS

In the table below, indicate all of the sector(s) that apply to your co-operative’s work and at least one (1) corresponding metric to track within each sector you choose:

Sectors

Arts ☐ Environment ☐ Food, Agriculture,

Fisheries ☐ Financial Services ☐

Met

rics

Number of new extracurricular programs offered to the community

☐

Energy conserved ☐

Percentage of suppliers who are smallholders ☐ Value of microfinance loans

disbursed ☐

Number of extracurricular programs offered to the

community ☐

GHG reductions ☐

Total units/volume purchased from local organizations ☐

Value of grants provided ☐

Square footage of community space built ☐

Number of individuals with new access to

renewable energy ☐

Amount of the product that is certified by a third party ☐

Number of clients served ☐

Land area conserved or protected ☐

Sectors (continued) Health ☐ Housing ☐ Social Enterprise ☐ Social Services ☐

Met

rics

Number of individuals with new access ☐ Individuals housed ☐

Jobs created at directly supported or financed

enterprises ☐

Square footage of community facilities

financed ☐

Square footage of healthcare facilities built or renovated

☐ Average affordability ☐

Revenue generated at directly supported or

financed enterprises ☐

Jobs created at directly supported or financed

enterprises ☐

Number of housing units constructed ☐

New businesses created in low income areas ☐

Number of individuals served ☐

Name 3 project-specific goals for your co-operative that you will track and the sector and impact metric(s) for each:

Goal 1: Sector 1: Metric(s) 1: Goal 2: Sector 2: Metric(s) 2: Goal 3: Sector 3: Metric(s) 3:



COMMUNITY IMPACT

CO-OPERATIVE VALUES

Please describe the community impact that will result from the financing your co-op receives from CCIF:

Please describe how your co-operative is embracing the seven co-operative values and principles:

NOTE: If your co-operative receives funding from CCIF, you will be required to report on the following co-operative-specific impact metrics, as applicable: 1) Number of new co-operative members/workers/customers/suppliers added to existing business; 2) Number of new co-operative enterprises created; 3) Number of partnerships created between co-operatives.



INDIGENOUS IMPACT

IMPACT MONITORING

Will your co-operative or project work specifically to promote positive impacts in Indigenous communities? ___ No ___ Yes

If yes, please select at least one of the four metrics below that you will track. You may also add additional metrics that are specific to your project. ☐ Number of Indigenous-owned businesses supported

☐ Number of new own-source revenue streams that are created to generate future investment back into the community

☐ Number of jobs created for Indigenous Peoples

☐ Number of projects that promote the safeguarding of natural resources on traditional territory with support of unique Indigenous knowledge

☐ _____________________________________________ ☐ _____________________________________________ ☐ _____________________________________________

How are you planning on collecting the data to track the above metrics and measure your impact? Do you have monitoring and measurement systems in place? Do you have dedicated impact staff in place? Please describe in detail:

Please see Appendix II for more information on CCIF’s impact measurement and management framework.



APPENDIX I – ENVIRONMENTAL QUESTIONNAIRE

The Environmental Site Inspection form (ESI) is to be completed by the Investee to provide environmental information regarding each property offered as security.

Instructions for Completion: The ESI must: be completed by the Investee and the Lender; be performed in conjunction with

current observations of the condition of the property; and reflect an understanding of the current status of environmental records, certificates, licenses and third-[party agreements.

Investees must provide representative photographs of the subject property and adjacent sites as an integral part of the ESI. The photographs must be dated and labels with the site description and the view presented.

The ESI declaration and certificate must be signed and dated by the Investee or an officially authorized representative of the Investee.

Section 1: General Information Name of Investee: Date of Report:

Property Address:

Describe current activities and operations on subject site:

Property Size (specify acres, hectares, square feet or square metres):

Type of Buildings on Property

Building # Levels Above Grade

Levels Below Grade

Building Size (sf) Year Built

Section 2: Background and Historical Site Information 1. How long has the Investee owned the property?____________________________

2. What is the drinking water source for the property? __________________________



3. To the best of your knowledge please respond to the following historical information questions:

What are the previous uses of the property over the past 50 years?

Was the property used as a gas station, dry cleaner, landfill/dump, quarry, waste treatment site or for heavy industrial use? ( Yes No Unknown) if yes, please describe:

Were aboveground or underground storage tanks for petroleum products or other liquid chemicals located at the property? ( Yes No Unknown) if yes, please describe:

Was an oil/water separator ever used at the property? ( Yes No Unknown) if yes, please describe:

Were other hazardous chemicals (pesticides, herbicides, fertilizer) stored in bulk quantities at the property? ( Yes No Unknown) if yes, please describe:

What are the historical heating sources for buildings on the property (other than natural gas)?

Was any fill material accepted onto the site for infill or grade level changes? ( Yes No Unknown) if yes, please describe:

Have previous structures existed on the site? ( Yes No Unknown) if yes, please describe:

4. Were any environmental investigations performed as part of acquisition due diligence for theproperty? ( Yes No Unknown. If Yes, please provide copies)

5. Have any environmental investigations been performed since acquiring the property?( Yes No Unknown. If Yes, please provide copies)

6.Have any environmental investigations indicated the presence of contaminants at the property?( Yes No Not Applicable)

If yes, was further assessment and/or remediation of contaminants necessary?

If yes, was remediation performed and completed?



If yes, please provide copies of remediation reports.

Section 3: Current Site Information and Observation

1. Are there currently any aboveground or underground storage tanks for petroleum products orother liquid chemicals located at the property? ( Yes No) if yes, please describe each tank:

Capacity, construction material and year of manufacture;

Contents:

Is the tank equipped with secondary containment?

2. Are hydraulic elevating devices used at the property (e.g. hoists, elevators, loading dock lifts)?( Yes No) if yes please describe:

3. Are spray paint booths operated at the property? ( Yes No) if yes please describe:

4. Are any individual drums or bulk containers of chemicals, pesticides, herbicides, fertilizer, paints,solvents, etc. located at the property? ( Yes No) if yes please describe:

5. Are production chemical and waste chemical storage are equipped with secondary containment(e.g. spill pans, dyked storage rooms, double-wall tanks) and protected from vehicular impact?( Yes No Not Applicable) if yes, please describe:

6. Is the property equipped with emergency power generating systems with associated fuelstorage? ( Yes No) if yes please describe:

7. Are there any environmentally-related easements, rights-of-way, etc. associated with oradjacent to the property (e.g. petroleum/gas wells, underground pipelines)? ( Yes No)if yes please describe:

8. Are any waste pits, floor sumps, cisterns, waste treatment facilities or waste treatmentponds/lagoons on the property? ( Yes No) if yes please describe:

9. Are oil/water separators currently in use on the property? If so, please describe:



10. Are any damaged or discarded automobile components, industrial batteries, chemicals or paint containers located on the property? ( Yes No) if yes please describe:

11. Is there any evidence of stained asphalt, concrete, gravel, damaged or dead vegetation or other evidence of spills or leaks observed on the property? ( Yes No) if yes please describe:

12. Are any unusual or noxious odours present? ( Yes No) if yes please describe:

13. Is there any evidence of any vent pipes, fill pipes, fuel pumps or other indications of current or historical underground storage tanks? ( Yes No) if yes please describe:

14. Is there any evidence of groundwater monitoring wells on the property or observed on nearby properties? ( Yes No) if yes please describe:

15. Is the property adjacent or nearby to any gas stations, bulk petroleum or chemical storage and handling facilities, dry cleaners, landfills/dumps, quarries, waste treatment sites or heavy industry? ( Yes No) if yes please describe:

16. Is the property adjacent or nearby to properties where improper storage, dumping, spillage, or leaks have been observed? ( Yes No) if yes please describe:

Section 4: Regulatory and Operational Compliance Management

1. Is there an officer of the company designated with specific responsibility for environmentalcompliance issues? ( Yes No) if yes, please identify:

2. Does the company have an environmental policy and associated environmental managementprocesses and training? ( Yes No) if yes, please describe:

3. Are all applicable environmental operating permits (e.g. waste generation, waste disposal, airemissions, Etc.) in place and in good standing? ( Yes No)

4. Does the property currently require, or is undergoing, remediation of contamination?( Yes No) if yes, please describe:



5. Are any environmentally-related regulatory orders, action or violations of permits or laws involving the property or site operations known to the Investee? ( Yes No) if yes, please describe:

6. Are any environmentally-related civil claims, actions, lawsuits, complaints or disputes by third-parties involving the property known to the Investee? ( Yes No) if yes, please describe:

7. Is the Investee aware of any pending changes to environmentally related statutes, regulations, or by-laws that could materially impact the property or business? ( Yes No) if yes, please describe:

8. Are the Investee’s operations at the property protected from environmental liability by insurance coverage? (Note – most general liability insurance policies specifically exclude claims related to environmental impacts). ( Yes No) if yes describe:

Additional Information:

1. Are there any other environmentally related issues at your facility that you wish to make usaware of when assessing your loan application? If so, please provide details:

2. Were there any circumstances beyond your control (e.g. weather conditions, on-site construction) that limited your ability to accurately complete this form? ( Yes No)if yes, please explain:

INVESTEE ATTESTATION: I declare that the information provide is true and complete. I understand that the information is required and will be relied upon by Community Forward Fund as part of its overall risk assessment of my/our loan application. I also understand that if these answers are found to be incorrect, then this could result in the rejection of the loan application or if the financing is already been provided, a loan default.

________________________ _______________________ ______________________ Investee Signature Title Date

If space is insufficient, please attach a separate page(s) referencing the question



CERTIFICATE OF OFFICER OF INVESTEE REGARDING ENVIRONMENTAL CONTAMINANTS

TO: Canadian Co-operative Investment Fund (hereinafter collectively referred to as the “Lender”)

This Certificate is delivered pursuant to subsection ix. of the Loan Agreements dated the _____ day of _________, 2018 between the Lender and ________________________________ (the “Investee”). Capitalized terms used in this Certificate and not defined herein shall have the meanings given to them in the Loan Agreement.

I, ____________________, __________________ of the Investee hereby certify on behalf of the Investee and not in my personal capacity that:

1. There are no un-remediated environmental contaminants located in or on the___________________________ property.

DATED at _______________, ___________ this day of __________, 2018.

Name:

_________________________________ Title:



APPENDIX II – Impact Measurement & Management Addendum

At CCIF, our team is passionate about enabling and strengthening the co-operative sector across Canada. It is important for us to track the impact of our financing to help ensure we are maintaining accountability to our mission, and to demonstrate our impacts to current and future investors and lenders.

In order to track information in a systematic manner, we have identified eight sectors that a co-operative will indicate as relevant based on its core mission. Co-operatives may choose as many sectors as are relevant. The follow are the sectors and their descriptors to help you identify which ones may apply:

1. Arts: A co-op working towards showcasing any form of human expression.2. Environment: A co-op working towards improving the state of the environment and the reduction of its

carbon footprint in any way.3. Food, Agriculture, Fisheries: A co-op working with small- or large- scale food and beverage, agricultural or

fishery supply chains.4. Financial Services: A co-op that provides microfinance loans or grants to other community organizations.5. Health: A co-op working towards bettering the mental or physical health of the community.6. Housing: A co-op working towards creating safe, affordable, appropriate housing for its community.7. Social Enterprise: A co-op working towards various social endeavours that are for profit.8. Social Services: A co-op working towards various social endeavours that are not-for-profit.

CCIF has identified 2-4 standardized metrics within each sector. Each co-operative is required to track least one metric within each sector that they indicate as relevant. This allows CCIF to aggregate data across its portfolio and indicate any positive impact by sector. In addition, all of the metrics chosen are related to the UN Sustainable Development Goals (SDG). The SDG’s are used as a guide of what impact to track.

Table 1.0 – Sectors & Metrics The metrics chosen are aggregated from IRIS, an initiative of the Global Impact Investing Network (GIIN) which is dedicated to increasing the scale and effectiveness of impact investing (IRIS, 2018). IRIS created standardized impact measurement metrics in order to support the transparency, credibility, and accountability of organization making a difference (IRIS, 2018).

In addition to the standardized, sectoral metrics, each co-op is to provide 1-3 project-specific goals that they will track. This is to provide the individual co-ops with the flexibility to showcase other goals that are important and specific to the core of their mission and projects that otherwise would have been missed with the standardized measures. CCIF also asks co-operatives to report on their impact on Indigenous communities and on their impact as it relates to the co-operative values and principles.

This data will be reported to our investors and to the public through case studies on our website, annual reports, and other presentations.

Canadian Co-operative Investment Fund...c4PJ!3+/*./A!*.!A;+/3.,R! J5??4+./A!4+!

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Canadian Co-operative Investment Fund...c4PJ!3+/./A!.!A;+/3.,R! J5??4+./A!4+!

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